Question:

At my daughter’s dental check-up today, things went as they normally did. However, upon examining the x-rays of my 6-year-old’s teeth, her dentist (whom we’ve been seeing since she cut her first teeth) blurted out “your child is missing a tooth”!! I was shocked, appalled and caught totally off guard. While I am trying to absorb this information my, now traumatized for life, daughter has this look of shock and heartbreak on her face and immediately bursts into hysterical crying. I thought the dentist was extremely tactless in saying this in front of my daughter without any discernment for her presence! Needless to say, I am now looking for a new pediatric dentist. The problem still remains. I looked at the x-ray and saw there was no incisor on the left of the upper arch. The dentist told me that there was pretty much nothing to be done and this is a common hereditary problem. No one in either her father’s or my family have had dental problems, we have ALL of our teeth. I had spaces in my teeth growing up but now I have ALL of mine including the four wisdoms. I’ve never heard of this before. She also claims that the canine will grow in the incisors place. Now my daughter will have three front teeth instead of four? How can this happen? What are my options? ( I know braces can help, but it will still affect her smile and personality after being traumatized in such a way). Is it possible that the tooth could be BEHIND the canine? Please help!!! I just need a “second opinion”. I will seek another dentist for her next visit.

Answer:

Missing permanent teeth are fairly common, and the upper lateral incisors are among the most frequently involved. The good news is that there are two good options for care, and after treatment your daughter will have a healthy and attractive smile.

One option is to allow the upper canine to erupt into the position of the missing lateral incisor and then close all the spaces orthodontically. The canine can be esthetically recontoured and restored to resemble the missing tooth. Sometimes this option involves extracting the opposite lateral incisor. While this sounds like radical treatment, it can yield beautiful and stable results in the right cases.

The other option is to use orthodontic braces to hold open the space for the missing lateral incisor. When your daughter’s growth is complete, an implant can be placed in the space of the missing tooth. For girls, this may be in the mid to late teens. An attractive “false” tooth can be attached to the braces to mask the missing one in the meantime.

The correct option for your daughter can only be determined after consultation with dentists in your area who are experienced in managing these problems. Do not hesitate to gather several opinions before you decide what is best for your daughter. 

For more information:

Go to the Dental and Oral Health (Children) health topic.